When Self-Care is an Excuse for Narcissism—and How to Spot the Difference


One spring a patient named Margot came to my office feeling despondent. She had recently attended a seminar on the importance of self-care, which was titled, “Make This Year All about You.” The two-hour workshop emphasized how prioritizing oneself was a must to achieve happiness. Margot was instructed to put herself at the top of her to-do list and begin each morning by looking in the mirror and asking, “What do I need today?” She was told to make regular “dates” with herself and to treat herself with a slice of her favorite cake or a manicure. At the end of the seminar, the attendees signed a contract pledging to give more love, kindness, and attention to themselves.

When Margot returned home, she withdrew from her book club so she could read the recommended self-help books. (Plus, she told me, because the club didn’t always choose books she liked, she felt further justified in her decision.) The signed pledge gave Margot the license to decline invitations that weren’t convenient or to her liking. She decided not to attend a friend’s birthday dinner because it wasn’t being held at a vegan restaurant. When her sister came to town for a visit, Margot barely made time to see her.

Margot focused on herself at the expense of other relationships and did see some positives. She was getting lots of sleep, eating a healthy diet, reading a self-help book a week, meeting with a life coach every two weeks, meditating 30 minutes a day, and getting plenty of exercise. For her vacation she canceled a visit to see her grandmother and opted instead for a silent retreat. Yet in spite of her efforts to give back to herself, Margot said that her efforts hadn’t provided the gain in happiness she had hoped for. If anything, she told me in almost a whisper, she felt worse.

When Self-Care is Really Narcissism

I let Margot know that she wasn’t alone in feeling let down. Putting yourself on a pedestal can actually erode well-being because it greenlights self-focus and cuts people off from others. I told her about an experiment in which volunteers were asked to choose one of three acts to perform each week for a month: to show kindness to others, to humanity, or to themselves. The groups that performed acts of kindness toward others or toward humanity experienced a greater boost than those who focused on themselves. A massage is relaxing and enjoyable in the moment, but the positive feeling fades quickly. When acts of kindness are other-oriented, not self-oriented, people feel better for longer. The study concluded that when “people do nice things for others, they may feel greater joy, contentment, and love, which in turn promote greater overall well-being and improve social relationships.” In short, a cascade of uplifts follows other-oriented actions—and they linger.

People also tend to feel better when they buy a gift for someone else than they do when they buy it for themselves. Plus, the happiness derived from giving things does not wear off in the same way as purchasing something for oneself does. Having can get boring but the “warm glow” of doing something for someone sustained itself over the course of the study. Self-care might be all the rage, but it’s important not to forget “other-care” as a source of vitality and resilience.

“What about the gratitude exercise I do every night?” Margot asked. “Shouldn’t that be making me happier?”

I asked her to elaborate. The seminar had told the attendees to list the things that made them grateful before going to sleep. Margot hadn’t missed a day, and I asked what had made her list the night before. Margot said she was grateful for a sweater her mother had given her: “I got so many compliments on it.” She was also grateful to a coworker for filling her in on the contents of a meeting she had missed. “It made me feel in the loop.”

Margot was dwelling on how these acts made her feel better, but research shows that the power of gratitude lies in expressing it toward others. I explained that there are two types of gratitude: “other-praising,” which recognizes someone else and strengthens social bonds, or self-benefit, which focuses on what the recipient has gained. Being grateful to her mother for being so thoughtful and to her coworker for being so helpful are examples of other-praising gratitude. Feeling “in the loop” and complimented is satisfying, but we lose the magic of gratitude when we make it all about us.

People who express gratitude toward others have stronger and more loving relationships. So, if your partner sends you flowers, you can relish how great the gesture made you feel, or you can channel your gratitude toward your partner by actively saying or doing something that acknowledges how awesome she is. It is the difference between saying, “Thank you for the flowers; they cheered me up,” versus “Thank you for the flowers. You cheered me up.” Think of showing gratitude as an expression but also as an action—as a verb that works best when it is embodied, spoken aloud, and when it connects you to someone else.

3 Ways to Avoid Self-Care Turning Into Self-Immersion

Margot wanted to be happy, but her quest had led her down an unfulfilling path of self-immersion. She had been seeking growth and connection. What she found was pseudo-growth and isolation. I explained to Margot that the more people value their personal happiness, the lonelier they feel on a daily basis.

“I guess I’m exhibit A,” she acknowledged.

Neuroscientist John Cacioppo has explored how loneliness leads to self-centeredness, developing a theory that has an evolutionary basis: for our ancestors, the experience of loneliness functioned as a warning system to take care of one’s immediate welfare and interests. “In modern society becoming more self-centered protects lonely people in the short term,” says Cacioppo, but the more self-immersed they become, the harder it is to reconnect socially.

Loneliness and self-centeredness create a feedback loop wherein one bolsters the other. This can lead to social isolation, which in turn can damage mental and physical health. When people are actively generous with others, they typically feel more competent in their ability to add value, to enact change, and to feel that they belong. Of course, it is important to take care of yourself—but don’t let self-care become an excuse for self-immersion. Here’s how:

  1. Do something nice for someone. Paying too much attention to what’s going on in our own heads can lead us to ignore stress-buffering experiences, connections, and opportunities. Jumping in and doing things for others is one of the most effective antidotes for everyday stress. Assisting a neighbor with groceries, giving a compliment, bringing a sick friend a bowl of soup, visiting grandparents, and volunteering at a library or shelter are all actions that can help us feel less rattled by the barrage of pebbles that get caught in our shoes.
  2. Have a time feast. It may be counterintuitive, but research shows the best way to feel as if you have more time—“time affluence”—is to give it away. Cassie Mogilner, who studies decision-making, led four experiments that showed people’s subjective sense of having time increases when it is spent on others. Being generous with your time (for example, by lending a hand to a friend, taking a neighbor’s dog for a walk, or through volunteering) boosts a person’s belief in his capacity to add value and make a difference, which shapes his perception of time. Mogilner and her co-researchers concluded, “We identify a specific choice that individuals can make to lessen their experienced time pressure: Be effective by helping others.”
  3. Forget the mask metaphor. “In the unlikely event of a loss of cabin pressure, oxygen masks will drop down. Secure your own mask first before helping others.” In the field of therapy, the oxygen mask has become a metaphor for prioritizing the self at all times and above all else. The message is loud and clear: Focus on your own needs. Look out for number one. Everything else can wait. This message lands easily on receptive ears. People tend to veer in the direction of self-interest when they are stressed out. And while I am not promoting self-neglect or martyrdom—nor am I recommending a life that rivals that of a doormat—too much self-focus can become an excuse to shut ourselves away from the rest of the world. There is nothing wrong with doing good things for yourself, but taken to the extreme, it can turn into a justification for self-absorption.

Adapted with permission from the book Everyday Vitality by Samantha Boardman, MD. 



Samantha Boardman is a New York-based positive psychiatrist. She is a clinical instructor in psychiatry and an attending psychiatrist at Weill Cornell Medical College. She received a BA from Harvard University, an MD from Weill Cornell Graduate School of Medical Sciences, and an MA in applied positive psychology from the University of Pennsylvania. Dr. Boardman is the founder of positiveprescription.com, a website devoted to making tweaks and changes that are life-enhancing and resilience-building by combining conventional medicine and psychiatry with positive psychology. To learn more visit positiveprescription.com.

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